Rheumatoid arthritis and positional vertebrobasilar insufficiency. Case report

Area of Science:

• Vascular Neurology
• Rheumatology
• Diagnostic Imaging

Background:

• Juvenile rheumatoid arthritis (JRA) is a chronic inflammatory condition that can affect various systems.
• Positional vertebral artery compression is a rare but serious complication that can lead to ischemic events.
• Understanding the interplay between inflammatory diseases and vascular complications is crucial for patient management.

Observation:

• A 45-year-old patient with a history of juvenile rheumatoid arthritis presented with symptoms suggestive of vertebrobasilar insufficiency.
• Digital subtraction angiography was performed with the patient's head in multiple positions to assess for dynamic arterial compression.
• Aortic arch injections were utilized to visualize the vertebral arteries and their relationship to cervical structures.

Findings:

• The study documented positional occlusions of the vertebral arteries.
• These occlusions were specifically observed when the patient's head was moved into certain positions during angiography.
• The findings suggest a link between the patient's underlying JRA and the development of dynamic vertebral artery compression.

Implications:

• This case highlights the importance of considering positional vertebral artery occlusion in patients with inflammatory conditions like JRA.
• Angiographic assessment with dynamic head positioning is a valuable diagnostic tool for identifying such occlusions.
• Early diagnosis and management of positional vertebral artery compression can help prevent potentially devastating neurological outcomes.